Thank you for referring Aaron d’Amore, a 33-year-old gentleman who is an office worker and an ex-smoker of less than five pack-years. As you are aware, around six weeks ago Aaron developed a pain in his buttock, posterior calf and ankles with associated swelling and indurated red rash in the left leg that sounds suspicious for erythema nodosum. He had a two-week course of prednisolone a week later with good response, but after ceasing steroids the symptoms returned. In the last week, Aaron has again commenced prednisolone 25mg daily with some improvement. As you are aware, he has had a recent chest x-ray that reveals impressive hilar lymphadenopathy. Adam reports some mild dyspnoea over the last year or so with episodic wheeze and chest tightness. There is no chronic cough. He is not aware of any gastro-intestinal or genito-uriniary issues or symptoms to suggest ocular …show more content…
Examination revealed an oxygen saturation of 96% and chest auscultation was clear. The was no cervical lymphadenopathy or obvious hepatosplenomegaly. On the left leg there was a circular mildly??? erythematous area that was non-blanching. Assessment: I do agree that Aaron’s presentation is suggestive of sarcoidosis, particularly Löfgren’s syndrome which is a variant involving erythema nodosum and lower limb arthritis. It tends to have a good prognosis and responds well to corticosteroids. I think it is important to confirm the diagnosis histologically, and I have arranged for Aaron to undergo a CT chest scan followed by a bronchoscopy with endobronchial ultrasound. He will undergo some additional pathology including a check of urinary calcium and an ECG. I will see him again in a few weeks at which point he will undergo lung function tests. Aaron will drop prednisolone to 12.5mg daily in the next few days and continue at this dose until I see him in a few
In general, he was a chronically ill-appearing white male in no acute distress. HEENT: The nasal mucosa on the right was erythematous and questionable polyp was present. No stridor over the neck. Chest increased AP diameter. Lungs: Diminished breath sounds through all lung fields with prolonged expiratory phase and expiratory wheezing. No crackles. No accessory muscle use. Heart: Very distant S1, S2. No murmurs, rubs, or gallops. Abdomen: Obese, nontender. No organomegaly. Extremities: 1+ pitting edema. No clubbing. No
The patient tells me this has been ongoing now for the last two months. There was no specific injury or trauma. She was describing a pain and ache in her right leg. She said she was not paying much attention to exactly where it was and elected to go see urgent care on September 3th. I do have that note from the physician that she saw there. At that time, her main complaint was right knee pain. She had x-rays done that showed some mild osteoarthritis and she is here today to follow up on that. She says after that visit, she really started trying to pay attention to where the pain was coming from and she realized it is really coming throughout the whole leg, particularly the thigh area, the knee, down the back of the leg as well, and she also feels it a little into the right buttock. No injury or trauma. There is no real low back pain associated with this. No weakness that she has noticed. No numbness or tingling that she has had. She is having no other joint issues that she can recall. She is not having fevers. There has been no redness or swelling. She is overall feeling okay. She is a little bit more tired than typical. No associated fevers, chills, or other body
On admission, a complete physical assessment was performed along with a blood and metabolic panel. The assessment revealed many positive and negative findings. J.P. was positive for dyspnea and a productive cough. She also was positive for dysuria and hematuria, but negative for flank pain. After close examination of her integumentary and musculoskeletal system, the examiner discovered a shiny firm shin on the right lower extremity with +2 edema complemented by severe pain. A set of baseline vitals were also performed revealing a blood pressure of 124/80, pulse of 87 beats per minute, oxygen saturation of 99%, temperature of 97.3 degrees Fahrenheit, and respiration of 12 breaths per minute. The blood and metabolic panel exposed several abnormal labs. A red blood cell count of 3.99, white blood cell count of 22.5, hemoglobin of 10.9, hematocrit of 33.7%, sodium level of 13, potassium level of 3.1, carbon dioxide level of 10, creatinine level of 3.24, glucose level of 200, and a BUN level of 33 were the abnormal labs.
Rosendo is a 32-year-old male who suffers from chronic plaque psoriasis (L40.0), along with psoriatic arthritis. His symptoms include dry, itchy, scaly, large, thick patches of plaques, located on his arms, back, legs, scalp, and behind his ears, as well as experiencing tenderness in the knees and fingers. Rosendo has tried and failed various treatments including triamcinolone, which provided little to no relief. Cosentyx was denied stating that the records sent do not show that he has tried another medication like Methotrexate, Cyclosporine or Acitretin. He is not a candidate for Methotrexate, Acitretin, and Cyclosporine as they have Black Box warnings due to the dangerousness of the side effects causes by these specific treatments, in addition
Chest auscultation reveals wheezes and decreased to absent breath sounds over the lower lung bases. Hyperresonance was noted upon percussion of the chest wall. Chest x-ray showed atelectasis in the lower lung bases. The patient has a cough with minimal amounts of clear sputum production.
Glen Carver is a 56 year old male who was admitted unto the cardiovascular care unit 48 hours ago with the diagnosis of heart failure. Mr. Carver went to see his primary care provider with complaints of dyspnea on exertion, a nonproduction cough, decreased activity intolerance, and general fatigue all of which have been worsening over the past two months. The primary care provider found Mr. Carver to have lower extremity swelling, profound ...
Per the medical report dated 05/17/16, the patient reported bilateral hand pain with numbness and tingling for the past 7 years or so, worsening, right greater than the left side. There is some degree of numbness/tingling on the right hand at all times. She has difficulty sleeping at night due to pain and driving, doing her hair/make up or holding objects worsen her symptoms. She has tried wearing splints that they worsened the discomfort. She denies any history of steroid injections. On examination, Tinel’s, Durkan’s and Phalen’s tests are positive bilaterally. There is bilateral thenar weakness.
Possible cellulitis/inflammatory process to LLE- Patient presents with pain to LLE. Erythema and swelling noted to medial upper thigh. Cellular injury at site may cause alterations to the plasma membrane, which
O:Right arm, wrist, and hand: no edema, discoloration noted, full ROM , tenderness with palpation
The patient is a 56-year-old gentleman who presented to the ED with a complaint of constipation for 5 days prior to presentation patient reports child the being bags of sunflower seeds 6 days prior to presentation and since that time he has not had a bowel movement. He reports some associated left lower quadrant pain 2/10, sharp and constant. He also reports associated increased urinary frequency and straining to urinate. He has no significant past medical history. He has tried some stool softeners etc. at home with no results. Clinical review of his records indicates he does have a mild elevation in his white count with a left shift. His SMA-18 reveals some hypokalemia. Urinalysis reveals a small amount of blood. A CT the abdomen
The patient was receiving a combination of oral prednisolone, hydroxychloroquine and methotrexate for her complaints of seronegative spondyloarthropathy. Further, to counter her dysthymia, she had been initiated on oral escitalopram two weeks prior to presenting in our hospital. Her blood sugar levels were being managed using a combination of fast and long acting insulin. Further, on obtaining a detailed history and after a thorough clinical examination, the mild abdominal pain was attributed to severe constipation. Her initial work-up revealed her to be severely hyponatraemic with serum sodium level of 107 mmol/L. Her previous sodium levels, prior to starting escitalopram, was normal (137.6 mmol/L). At this juncture, in view of a possibility of drug induced hyponatraemia, escitalopram was withheld. Further investigations revealed high urinary sodium level (36 mmol\L), elevated urinary osmolality (291 mmol/kg) and reduced serum osmolarity (235 mmol\kg). The low serum urea (11.0 mg/dL), serum creatinine (0.4mg\dL) and low uric acid (2.2 mg/dL) added substance to the
On office screening, he scores 18/30 on a mini-mental status test. On physical examination, he has bilateral crackles on lung auscultation and an accentuated
You arrive on scene at a brown house with lights on and door open. To a patient that skin is pink warm (normal). Blood pressure 112/76 and pulse 61. Pupils are Equal and reactive, patent airway, says hurts to breath in once in a while. He says the pain has been radiating from his back, then side, then inner thigh/abdomen area for 2 weeks or so. No vomiting or nausea, no allergies, takes vitamins every day, fish oil. No meds, no pertinent past history, ate a tuna sandwich earlier that day with some red bull. The pain has just been generally getting worse for the past 2 weeks. He thought he pulled a muscle during
The blood test confirmed that there was indeed an infection going on with the elevated WBC count. The Gram stain remained inconclusive as there was no firm evidence that there was a pathogen present in the sputum. The x-ray was a big piece of evidence to figuring it all out. The patchy areas narrowed things down with pneumonia and tuberculosis. The ELISA test was what allowed the doctor to make his diagnosis. The ELISA test revealed there were antibodies present for the bacterium Mycoplasma pneumoniae (Bono, 2018). The doctor knew this meant John had walking pneumonia, also known as atypical
Patient is 5’7” tall and weighs 195lbs. Labs revealed a high WBC at 18.6, a low Hgb at 11.1, a low Hct at 32.8, and a low MCV at 79. High neutrophils count at 76, low lymphocytes of 16 and a HgbA1c of 8.7. Glucose measured high at 133, and BUN was high at 28. Protein and Albumin low at 5.9 and 3.4. Patients LDL was high at 124. Urine protein was high with 1+ and glucose 1+ as well. The bacterial culture of right foot indicated Staphylococcus aureus. Right foot x-ray showed mild degenerative changes accelerated for patient’s age and mild dorsal soft tissue swelling in the forefront. No acute osseous finding in the right foot or ankle.